Provider Demographics
NPI:1346551843
Name:NATHE, CANDY (CMT)
Entity Type:Individual
Prefix:
First Name:CANDY
Middle Name:
Last Name:NATHE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 HIGHWAY 29 N
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-5011
Mailing Address - Country:US
Mailing Address - Phone:320-766-0345
Mailing Address - Fax:
Practice Address - Street 1:901 HIGHWAY 29 N
Practice Address - Street 2:SUITE 105
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-5011
Practice Address - Country:US
Practice Address - Phone:320-766-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCERTIFIED172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN71479OtherWORKERS COMP